Kubo S, et al. - Using a contemporary large-scale nationwide Japanese percutaneous coronary intervention (PCI) registry, researchers assessed in-hospital outcomes and the volume-outcome relationship in acute coronary syndrome (ACS) patients with cardiogenic shock (CS) by assessing 253,355 patients undergoing PCI for ACS, 17,549 (6.9%) of whom had cardiogenic shock (CS). PCI procedural data were analyzed and using multivariable logistic regression analysis, they determined the predictors of in-hospital death and major bleeding complications requiring transfusion. The factors that showed association with in-hospital mortality and bleeding complications included age, sex, and baseline kidney condition, along with presentation status (eg, cardiopulmonary arrest and/or acute heart failure) or the number and location of diseased vessels (eg, left main lesion). In ACS patients with CS undergoing contemporary PCI, 13.2% suffered in-hospital mortality. Higher in-hospital mortality was observed in relation to lower institutional PCI volumes and concurrent bleeding, beyond the traditional prognosticators of PCI complications.